Microbiology- a clinical approach by Anthony Strelkauskas et al Chapter 18: Control of microbial growth with disinfectants and antiseptics

MICR 201 Quiz #2 – Wednesday, May 15, 12:50-1:20pm  Chapters 14, 15, 16, 17 (up to HIV)  Multiple Choice, T/F; 25 questions, 50 points  Lecture, Chapter Questions  Please bring Scantron, No. 2 pencil

 Infection control using disinfectants and antiseptics is essential to keep infections from spreading, particularly in hospitals. © Health Protection Agency / Science Photo Library

 Sterilization – the removal of all living microbes including viruses and spores.  Disinfection – kill or inhibit growth of microorganisms by chemical or physical means. ◦ Chemical to achieve this used on inanimate object is called a disinfectant. ◦ The chemical to achieve this used on skin and tissue is called an antiseptic. ◦ Some chemical can be used for both disinfection and antiseptic treatment. ◦ Some disinfecting agents do not affect spores.  Aseptic – an environment or procedure free from contamination

 De-germing – the removal of microbes from a surface by mechanical means  Pasteurization – using heat to kill pathogens and spoilage microbes ◦ Does not sterilize but is used to reduce number of pathogens ◦ Also reduces the number of organisms that can cause spoilage

 Sanitization – disinfection of places or things used by the public ◦ Used to reduce the number of pathogens to meet accepted public health standards ◦ Procedure to make the environment safe for the public  Sanitization is not sterilization but the same techniques can be used. ◦ Steaming ◦ High-pressure ◦ High-temperature ◦ Washing and scrubbing

 -static – an agent that inhibits growth ◦ In a bacteriostatic environment, numbers do not multiply but organisms are not dead.  -cidal – an agent that kills Time [h] CFU/ml Add antimicrobial

 Bacteria are single-celled organisms with a simple anatomy.  There are 4 major targets for antimicrobial compounds ◦ Cell wall ◦ Plasma membrane ◦ Proteins ◦ Nucleic acids

 Permanent loss of reproductive capability even under optimal growth conditions is the accepted definition of microbial death.  The most efficient way to determine whether a microorganism is dead is to determine whether it can still reproduce. ◦ Move it from the antimicrobial environment to fresh media that is known to support growth. ◦ If there is no growth, the organism is dead.

 Several factors affect the rate of microbial death in a clinical setting: ◦ Numbers and types of microbes ◦ Duration of exposure ◦ Temperature ◦ Environment ◦ Endospore formation  Death rate is measured logarithmically Death rate

 Numbers – the greater the number of organisms, the longer it will take to kill ◦ If large numbers of organisms are present, it takes time for the agent to reach them all.  Duration of exposure can vary depending on: ◦ Accessibility ◦ Type of microbe ◦ This is important to consider when using radiation treatment.  Temperature – the lower the temperature, the longer it will take to kill

 The environment – particularly important in health care environments ◦ Many pathogens are associated with organic materials.  Blood  Saliva  Bodily fluids  Fecal material ◦ These inhibit accessibility of the antimicrobial agent to the organism.

 Endospore formation – may be the most important factor  Spore-forming organisms are not susceptible to most chemical agents.  This is especially important for nosocomial infections with spore formers. ◦ Clostridium difficile

 There are three major methods for controlling microbial growth: ◦ Chemical  Liquids  Gases ◦ Physical  Heat  Radiation ◦ Mechanical removal  Filtration  Swiping

 Humans and microbes function according to very similar principles.  Agents that harm microbes can also harm humans.  Antimicrobial agents and methods must also be safe to use for humans.

 Factors to consider when evaluating effectiveness are: ◦ Time ◦ Temperature ◦ Concentration

 For most chemical agents, increase in concentration = increase in its potency.  This is not true for alcohol. ◦ Increase in alcohol concentration actually hinders killing. ◦ Alcohol must have some water associated with it.  This makes for better penetration and denaturation of proteins.  70% is better than 100%

 There is no completely satisfactory method for evaluating antimicrobial chemical agents.  Examples for evaluating the potency of antimicrobial chemical agents include: ◦ Comparison of the agent with phenol – the phenol coefficient ◦ Disk method

 Some chemical agents are better for certain uses than others.  Qualities to be considered include: ◦ Is it reactive against all types of organisms without destroying tissue. ◦ Is it effective in the presence of organic material and other environmental factors such as pH and temperature. ◦ How quickly should it act? ◦ Is it stable and, if possible, inexpensive.

 There are eight major categories of chemical agents:

 Phenolic compounds are derived from phenol. ◦ Many have greater efficacy and fewer side effects than phenol.  Phenols and phenolic compounds are low-level to intermediate- level disinfectants and antiseptics that: ◦ Denature proteins ◦ Disrupt the plasma membrane ◦ Triclosan inhibits fatty acid synthesis at low concentrations ◦ Remain very effective in the presence of organic material ◦ Remain active for prolonged periods  They are commonly used as disinfectants in health care settings and laboratories.

 Alcohols are bacteriocidal, fungicidal, and virucidal for enveloped viruses.  They have no effect on fungal spores and bacterial endospores.  They are intermediate-level disinfectants.  Alcohol is often used to carry other antimicrobial chemicals. ◦ This is referred to as a tincture.  Alcohol denatures proteins and disrupts the plasma membrane.  It has the added benefit of being capable of evaporating.  It is routinely used as a de-germing agent to prepare sites for injection.

 Four members of this chemical family have antimicrobial activity: ◦ Iodine ◦ Chlorine ◦ Bromine ◦ Fluorine

 Iodine is used medically as a tincture (in alcohol) or as an iodophor (in organic compounds).  Iodophors are longer lasting and non-irritating.  Betadine is an example of an iodophor. ◦ It is routinely used to prepare skin for surgery. ◦ It is also used to treat burns.

 Chlorine is found in drinking water, swimming pools, and waste-water. ◦ It is major ingredient in disinfectants such as chlorine bleach. ◦ It is used to disinfect kidney-dialysis equipment.  Chloramines are combinations of chlorine and ammonia. ◦ Used in wound dressings, skin antiseptics, water supplies. ◦ Less effective than chlorine as disinfectants/antiseptics. ◦ Release their chlorine atoms more slowly therefore last longer.

 Oxidizing agents are high-level disinfectants and antiseptics that prohibit bacterial metabolism.  They release hydroxyl radicals which kill anaerobic organisms.  They are very effective against infections of deep tissues.  They are routinely used in deep puncture wounds.

 Hydrogen peroxide: is a common household antiseptic.  Ozone: some cities use it for water treatment. ◦ It is expensive to produce. ◦ It is difficult to maintain at the proper concentration.  Peracetic acid: is the peroxide form of acetic acid and an extremely effective sporicide. ◦ It is used to sterilize surfaces and medical and food processing equipment.

 Soaps ◦ Ionic/hydrophilic end and a hydrophobic end (fatty acid) ◦ Break up oils ◦ Good for degerming  Detergents ◦ Positively charged organic surfactants ◦ Quaternary ammonium compounds (QUATS) are the most popular ones (e.g. benzalkonium) ◦ Can be used as mouth wash and for industrial applications

 The ions of heavy metals are inherently antimicrobial.  Heavy metals include: ◦ Arsenic, zinc, mercury, silver, copper  Mercury and silver were formerly used in clinical situations. ◦ Mercury has been abandoned. ◦ Silver is still occasionally used in:  Surgical dressings  Burn creams  Catheters

 Aldehydes cross-link to organic functional groups. ◦ These reactions denature proteins and inactivate nucleic acids.  Two highly reactive aldehydes are used as antimicrobials: ◦ Glutaraldehyde – used in liquid form ◦ Formaldehyde – used in both liquid form and gaseous form; formalin is 37 % formaledhyde  Also used for fixing tissues and proteins for preservation.

 Many items cannot be sterilized with heat or chemicals.  They can be sterilized using highly reactive antimicrobial and sporicidal gases. ◦ Ethylene oxide  Gases penetrate and diffuse into any space.  Over time (14 – 18 h), they can denature proteins and DNA.  They kill everything they come in contact with and cause no damage to inanimate objects.  Disadvantages: slow, explosive, and potentially carcinogenic

 Physical methods for controlling microbial growth include: ◦ Drying ◦ Heating ◦ Cold (slows growth but in most cases does not kill) ◦ Filtration (mechanical) ◦ Osmotic pressure ◦ Radiation

 Heat is usually lethal to most pathogenic microbes.  Two types of heat can be used: ◦ Moist heat  from hot water, boiling water, or pressurized steam as used in an autoclave  acts faster ◦ Dry heat  from hot air with low moisture e.g. from ovens or bunsen burner (much higher temperatures)  Needs more time

 Adequate sterilization with heat depends on: ◦ Temperature ◦ Length of time  Higher temperatures require shorter treatment times.  Thermal death time (TDT) is the shortest length of time needed to kill all organisms at a specific temperature.  Thermal death point (TDP) is the lowest temperature needed to kill all organisms in 10 minutes.

For endosporesSelected organisms Boiling does not kill endospores!

 Pressurized steam ◦ Temperature is above boiling with the aid of pressure ◦ Autoclave: 121°C 15 min at 15 psi ◦ Sterilizes  Boiling ◦ It is effective for disinfection ◦ 30 minutes kills most non spore-forming pathogens  Pasteurization ◦ Reduces microbial load but does not sterilize ◦ Kills pathogens while preserving taste and nutritional value ◦ Flash: 71.6˚C for 15 min ◦ Batch: 63-66˚C for 30 min

 Filtration is useful for sterilizing liquids.  It involves passing the liquid through membrane filters. ◦ Pores in the filter are too small to allow for the passage of microorganisms. ◦ Filters are made with specific pore sizes.  Filters can be used for: ◦ Growth media ◦ Drugs ◦ Vitamins ◦ Some commercial food preparation  Filtration is used to sample and test water samples for fecal coliform contamination

 Filters can also purify air. ◦ High-efficiency particulate air filters are called HEPA filters. ◦ These are seen in operating rooms, burn units, clean rooms of laboratories. ◦ They are used in laboratory facilities such as the Centers for Disease Control (CDC) to keep organisms from escaping.  Filters are soaked in formalin before disposal.

 Osmotic pressure has been used in food preservation for many decades.  High concentrations of salt or sugar or other substances are used in food preservation because: ◦ It creates a hypertonic medium. ◦ It draws water from the organisms. ◦ It leads to plasmolysis and death.

 Radiation energy emitted from atomic activities, dispersed at high velocity.  Cells absorb energy which changes DNA structure.  Ionizing radiation – electrons ejected from the atoms ◦ Gamma rays, X-rays, and high-speed electron beams ◦ DNA very sensitive to this radiation. ◦ Causes the breakdown of chromosomes. ◦ Can penetrate material ◦ Used for food, drugs, vaccines  Non-ionizing radiation – excites atoms, does not ionize ◦ With ultraviolet radiation ◦ Abnormal bonds within molecules, formation of thymine dimers. ◦ Germicidal lamps in hospital rooms, operating rooms, food preparation areas, dental offices; also water disinfection. ◦ Penetrates poorly ◦ Cause eye damage, cancer, skin wrinkling

 Hand washing is one of the most important historical discoveries in medicine.  The simple act of washing your hands can inhibit the spread of pathogens.  The effectiveness of hand washing is related to: ◦ The type of soap used ◦ The time taken  Hospitals use bacteriocidal soaps because they are very effective at preventing pathogen transmission.  Household soap can be effective if enough time is taken to do the job thoroughly. ◦ As long as it takes to sing the “Happy birthday” song

a) Sterilization is the removal of all living microbes. b) Disinfection is to kill or inhibit growth of microorganisms. c) Pasteurization uses heat to kill pathogens and spoilage microbes. d) Sanitization is the sterilization of places or things used by the public. e) All definitions are correct.

A. is the shortest length of time needed to kill all organisms at a specific temperature. B. is the shortest length of time needed to kill all organisms at 40 degree C. C. is the lowest temperature needed to kill all organisms in 10 minutes. D. is the lowest temperature needed to kill all organisms in 100 minutes. E. measured in relation to the activity of phenol.

 The cell wall, plasma membrane, proteins, and nucleic acids are targets for disinfectants and antiseptics.  Several factors affect the rate of death in bacteria, including the number of organisms present, presence of organic material, the duration of treatment, temperature, environment, and the ability to form an endospore.  The potency of antiseptics and disinfectants can be affected by temperature and concentration.

 Three tests are used to evaluate disinfectants and antiseptics: the phenol coefficient test, the disk method, and the use dilution test.  There are eight major categories of chemical agent used as antiseptics and/or disinfectants: phenol and phenolics, alcohols, halogens, oxidizing agents, surfactants, heavy metals, aldehydes, gaseous agents.  Heat, cold, desiccation, filtration, osmotic pressure, and radiation are physical methods used to control microbial growth.